Comparison of the Efficacy of adjuvant External Beam Radiotherapy, Vaginal Brachytherapy, and External Beam Radiotherapy with Vaginal Brachytherapy in Patients with FIGO Stage IB Endometrioid carcinoma: A Meta-Analysis

Abstract

Objective: Currently, there is debate surrounding the selection of adjuvant treatment for FIGO IB endometrioid carcinoma.The aim of this study is to compare the efficacy of postoperative adjuvant external beam radiotherapy (EBRT), vaginal brachytherapy (VBT), and the combination therapy of EBRT with VBT (EBRT+VBT) in patients with stage IB endometrioid carcinoma. Methods: We selected randomized controlled trials comparing postoperative adjuvant EBRT, VBT, and EBRT+VBT in patients with stage IB endometrioid carcinoma. Data analysis was performed using Review Manager 5.4.1. The primary study endpoints included 5-year overall survival (OS), 5-year disease-free survival (DFS), rates of distant metastasis, and rates of local recurrence. Secondary endpoints encompassed post-radiotherapy toxicities such as gastrointestinal toxicity, urinary toxicity, vaginal toxicity, and health-related quality of life scores (HRQL). Result: Survival findings: ①There were no statistically significant differences observed between the EBRT group and the VBT group in terms of 5-year OS (RR=1.02, 95% CI: 0.98-1.06, P=0.42), 5-year DFS (RR=1.05, 95% CI: 0.94-1.18, P=0.40), and 5-year distant metastasis rate (RR=0.69, 95% CI: 0.44-1.07, P=0.09). ②Compared to the VBT group, the EBRT+VBT group exhibited a significantly prolonged 5-year DFS (RR=1.16, 95% CI: 1.06-1.27, P=0.0010), reduced rates of local recurrence (RR=0.32, 95% CI: 0.13-0.75, P=0.009), and distant metastasis (RR=0.56, 95% CI: 0.32-0.96, P=0.03), but did not show improvement of 5-year OS in patients(RR=1.01, 95% CI: 0.97-1.05, P=0.73). ③There was no statistically significant difference observed in 5-year OS between the EBRT group and the EBRT+VBT group (RR=0.98, 95% CI: 0.93-1.03, P=0.46). Toxic outcomes: ①At 12 months, the diarrhea score in the VBT group was significantly lower than that in the EBRT group (RR=8.56, 95% CI: 5.38-11.91, P＜0.00001); the social function score in the VBT group was significantly higher than that in the EBRT group (RR=-5.60, 95% CI: -8.33--2.88, P＜0.0001). There were no statistically significant differences in the global health status score (RR=-1.80, 95% CI: -4.36-0.75, P=0.17) and urinary urgency score (RR=4.04, 95% CI: -0.81-8.90, P=0.10). ②Compared to the EBRT+VBT group, the VBT group had a lower incidence rate of gastrointestinal toxicity at 5 years, with statistically significant differences (RR=3.90, 95% CI: 2.18-7.00, P＜0.00001); there were no statistically significant differences in the rates of genitourinary toxicity (RR=1.68, 95% CI: 0.65-4.34, P=0.28) and vaginal toxicity (RR=1.76, 95% CI: 0.56-5.53, P=0.33). Conclusion: 1.There was no significant difference in 5-year OS in patients with stage IB endometrial carcinoma treated with VBT, EBRT and EBRT+VBT after surgery. Compared with VBT and EBRT, EBRT+VBT significantly extended DFS for 5 years and reduced the incidence of local recurrence and distant metastasis. 2.Although there was no significant difference between VBT and EBRT in overall health status score and urgency of urination score, VBT was superior to EBRT in diarrhea score, other gastrointestinal toxicity and social function score.